Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 057.000989 | IL |
NPI | 1023436441 |
---|---|
Provider Name | Nathalie Reisman |
First Address | Northbrook, IL 60062-5936 |
Second Address | Wheeling, IL 60090-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 02/04/2014 |